What the panel ordered
Petition for Reconsideration denied
Petition for Reconsideration of WCJ's Rulings, Findings of Fact & Order of August 1, 2023
What was disputed, and how it came out
Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.
The WCJ found no industrial injury during the cumulative period ending May 24, 2019, and the WCAB upheld this finding, noting the defendant did not timely deny liability but rebutted the presumption of injury with medical evidence not reasonably obtainable within 90 days.
From the decision · page 1Applicant seeks reconsideration of a workers' compensation administrative law judge's (WCJ) Rulings, Findings of Fact & Order of August 1, 2023, wherein it was found that, while employed during a cumulative period ending May 24, 2019, applicant did not sustain an industrial dental injury. The WCJ thus ordered that applicant take nothing by way of his workers' compensation claim.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Medical reports unanimously indicated the applicant's condition was not industrial
Favours Defendant prevailed
This evidence rebutted the presumption of industrial injury despite defendant's failure to timely deny liability.
From the decision · page 1Applicant seeks reconsideration of a workers' compensation administrative law judge's (WCJ) Rulings, Findings of Fact & Order of August 1, 2023, wherein it was found that, while employed during a cumulative period ending May 24, 2019, applicant did not sustain an industrial dental injury. The WCJ thus ordered that applicant take nothing by way of his workers' compensation claim.
Defendant conducted a reasonable and timely investigation after claim filing
Favours Defendant prevailed
The investigation included initial evaluation and dental examination within a reasonable timeframe, supporting rebuttal of presumption.
From the decision · page 2But the facts are otherwise. An initial evaluation at an industrial clinic was provided thirteen days after the filing of the claim form. The initial examination indicated that a dental examination was needed. Joint Exhibit B-4: Report of Sriram Mummaneni, M.D. 1/22/2020 pp. 6-7 (review of Doctor's First Report of Irene Sanchez, M.D./Stephen Hanson, PA-C 8/02/2019). The recommended dental exam occurred thirty-five days later. The initial dentist, in turn, recommended Qualified Medical Evaluation. Joint Exhibit B-4: Report of Sriram Mummaneni, M.D. 1/22/2020 p. 7 (review of Doctor's First Report of Chap Yam, D.D.S. 9/06/2019). Even if the Defendant did not deserve any prizes for promptly getting sufficient MSDS sheets to the QMEs thereafter, the initial investigation upon receipt of the claim form was both reasonable and timely.
What the panel did with the medical opinions
The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.
Medical reports unanimously indicated the applicant's condition was not industrial.
The medical reports were considered properly as they were not reasonably obtainable within 90 days of the claim form receipt, supporting rebuttal of the presumption of injury.
From the decision · page 1Applicant seeks reconsideration of a workers' compensation administrative law judge's (WCJ) Rulings, Findings of Fact & Order of August 1, 2023, wherein it was found that, while employed during a cumulative period ending May 24, 2019, applicant did not sustain an industrial dental injury. The WCJ thus ordered that applicant take nothing by way of his workers' compensation claim.
Provided initial evaluation and report indicating need for dental examination and Qualified Medical Evaluation.
His report was part of the evidence showing a reasonable and timely investigation by the defendant.
From the decision · page 2But the facts are otherwise. An initial evaluation at an industrial clinic was provided thirteen days after the filing of the claim form. The initial examination indicated that a dental examination was needed. Joint Exhibit B-4: Report of Sriram Mummaneni, M.D. 1/22/2020 pp. 6-7 (review of Doctor's First Report of Irene Sanchez, M.D./Stephen Hanson, PA-C 8/02/2019). The recommended dental exam occurred thirty-five days later. The initial dentist, in turn, recommended Qualified Medical Evaluation. Joint Exhibit B-4: Report of Sriram Mummaneni, M.D. 1/22/2020 p. 7 (review of Doctor's First Report of Chap Yam, D.D.S. 9/06/2019). Even if the Defendant did not deserve any prizes for promptly getting sufficient MSDS sheets to the QMEs thereafter, the initial investigation upon receipt of the claim form was both reasonable and timely.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code section 5402(b)
Presumption of injury under Labor Code section 5402(b)
Presumption applies if defendant does not deny liability within 90 days of claim filing, but can be rebutted by evidence not reasonably obtainable in that period.
From the decision · page 1Applicant contends that the WCJ erred in not finding industrial injury, arguing that he was entitled to the presumption of injury codified in Labor Code section 5402(b) because defendant did not deny liability for injury within 90 days of applicant's filing of a DWC-1 claim form. The WCJ found that, while the defendant did not timely deny liability, any presumption of injury was properly rebutted by evidence not reasonably obtainable in the 90-day period. We have received an Answer from the defendant, and the WCJ has filed a Report and Recommendation on Petition for Reconsideration (Report).
Labor Code section 5703
Appeals Board authority to receive medical reports at any time to prove or disprove facts
Allows the Board to consider medical reports obtained after 90 days to rebut presumption of injury.
From the decision · page 2Finally, the first argument of the pending petition overlooks the power of the Appeals Board to develop the medical-legal record regardless of the follies of the litigants. The Appeal Board is expressly authorized to receive the reports of attending or examining physicians at any time and use those reports to prove or disprove any fact in dispute. Lab.C. § 5703. Defendant correctly argues that chemical exposures are complex matters that require discovery that cannot be reasonably completed within 90 days. Answer to Petition for Reconsideration 9/07/2023 p. 3 lines 5-22. Moreover, written reports from physicians remain the favored mode for the production of evidence to the Appeals Board. 8 CCR § 10682 (WCAB Rule 10682).
8 CCR 10682
Written reports from physicians are favored evidence under 8 CCR 10682
Supports the use of medical reports obtained after 90 days in the Appeals Board proceedings.
From the decision · page 2Finally, the first argument of the pending petition overlooks the power of the Appeals Board to develop the medical-legal record regardless of the follies of the litigants. The Appeal Board is expressly authorized to receive the reports of attending or examining physicians at any time and use those reports to prove or disprove any fact in dispute. Lab.C. § 5703. Defendant correctly argues that chemical exposures are complex matters that require discovery that cannot be reasonably completed within 90 days. Answer to Petition for Reconsideration 9/07/2023 p. 3 lines 5-22. Moreover, written reports from physicians remain the favored mode for the production of evidence to the Appeals Board. 8 CCR § 10682 (WCAB Rule 10682).
What proof carried it
The evidence the panel weighed, by kind.
Medical reports unanimously indicated non-industrial condition
From the decision · page 1Applicant seeks reconsideration of a workers' compensation administrative law judge's (WCJ) Rulings, Findings of Fact & Order of August 1, 2023, wherein it was found that, while employed during a cumulative period ending May 24, 2019, applicant did not sustain an industrial dental injury. The WCJ thus ordered that applicant take nothing by way of his workers' compensation claim.
Initial evaluation at industrial clinic and dental examination timely conducted
From the decision · page 2But the facts are otherwise. An initial evaluation at an industrial clinic was provided thirteen days after the filing of the claim form. The initial examination indicated that a dental examination was needed. Joint Exhibit B-4: Report of Sriram Mummaneni, M.D. 1/22/2020 pp. 6-7 (review of Doctor's First Report of Irene Sanchez, M.D./Stephen Hanson, PA-C 8/02/2019). The recommended dental exam occurred thirty-five days later. The initial dentist, in turn, recommended Qualified Medical Evaluation. Joint Exhibit B-4: Report of Sriram Mummaneni, M.D. 1/22/2020 p. 7 (review of Doctor's First Report of Chap Yam, D.D.S. 9/06/2019). Even if the Defendant did not deserve any prizes for promptly getting sufficient MSDS sheets to the QMEs thereafter, the initial investigation upon receipt of the claim form was both reasonable and timely.
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About this page
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